Factors to Compare Health Insurance Policies

Not all health insurance policies are the same. The fine-print of each insurance policy will tell you what the health insurance policy covers, the inclusions and exclusions, the sub-limits, whether they support cashless hospitalisation, and so on. Choosing the health plan which comes with the lowest premium is not always the best option, and you should look at the premium as the last factor before you decide on a policy. A cheaper health insurance policy may prove to be costly later. You should make a thorough comparison between the terms and conditions of each policy to find one which suits you best. To help you with your decision, we have curated a list of the most important factors to consider while buying health insurance.

Type of Policy

There are various types of health insurance policies available on the market. The most basic type of policy is personal health insurance which only covers you as an individual and does not benefit your family or your dependents. If you have a family, then it is advisable to choose a family floater health insurance policy. A family floater allows you to cover your entire family’s medical needs through a larger common pool. This means that a sum insured of Rs. 4 lakhs can be used to reimburse the medical expenditure of any member of the family or multiple members of the family, as needed. Another type of health insurance policy is senior citizen insurance which is meant to cater to the specific needs of older individuals who are more prone to having health problems.

1. Customer Service

You need to be able to trust your insurance provider to be there for you when you need them. A medical emergency can occur at any time, and an insurance provider must be available for 24 x 7 to support you with timely responses. They should also have a fast timeline for processing claims. The claim procedure should ideally be as simple, straightforward and hassle-free as possible. You can check the after-sales customer service of each insurance provider through customer reviews online. Another option is to talk to your friends and extended family about their insurance providers and ask them about their experience.

2. Day Care Treatments

A health insurance policy not just covers illnesses which require you to be hospitalised for multiple days. These days many surgical procedures can be done in a few hours and you are discharged within the same day, such as a cataract operation. This type of surgical procedure is known as day care surgery. Before you settle on a health insurance policy, you should make sure that your policy covers day care procedures. The more types of day care procedures that the health plan supports, the better it is.

3. Pre-existing Conditions

An important rider which comes with almost all health insurance policies is that they do not cover pre-existing conditions for a certain period of time. This means that if you had an existing medical condition at the time when you bought the health insurance policy, you cannot make a claim for reimbursement of expenses related to the treatment of that medical condition. Generally, the time period for which you have to wait before you can make a claim for pre-existing conditions is between two to four years. In case you have a pre-existing medical condition, you should choose a health plan which has a shorter waiting period after which you can make claims relating to that condition.

4. Initial Waiting Period

Sometimes, individuals choose to buy a health insurance policy when they suffer with a medical problem to make the insurance provider pay for their treatment. In order to mitigate such instances, insurance providers have a waiting period of a few days to months after buying the health insurance policy. A policyholder cannot make a claim with the insurance provider for the reimbursement of medical expenses for the duration of this waiting period except for accident cases. Generally, the waiting period lasts between one to two months. You should opt for a health plan which has a shorter waiting period before which you can make a claim because you do not know when a medical problem may arise.

5. Cashless Hospitalisation

This is a highly desirable feature that many insurance providers include in their health insurance policies. Cashless hospitalisation allows you to undergo medical treatment at a hospital without the need for you to make a payment. The insurance provider will directly pay the hospital for your medical expenses, once your claim is processed. However, this feature only works with networked hospitals which are selected by your insurance provider and has entered into such agreements. You should check the list of networked hospitals of all health insurance providers to ensure that your local hospitals are included. Having a networked hospital near you will allow you to undergo your treatment at such a hospital without any expenditure of your own, if your health insurance policy covers the treatment. In order to know which hospitals are networked hospitals, you should check the insurance provider’s website.

6. Sub-limits

Insurance providers have a restriction on the amount which can be claimed for the treatment of certain illnesses. These are known as sub-limits. Even though the sum insured of your policy may be Rs. 2 lakhs, there may be a sub-limit for the treatment of an illness such as cataract of Rs. 20,000. This means that you can only claim a maximum of Rs. 20,000 for the surgical treatment of cataract. The most common illnesses which have a sub-limit are kidney stones, hernias and cataracts. You should look for health insurance plans which have a high sub-limit for such illnesses or do not have a sub-limit at all. If you or all the members of your family are young, then the chances of anyone contracting illnesses such as cataract are minute. In such circumstances, you can opt for a health insurance policy which has a low sub-limit for such illnesses.

7. Age Limit

Certain health insurance policies have a specified age limit beyond which you cannot renew your policy. It is a daunting task to buy a fresh policy at an older age because they charge much higher premiums and also have a larger list of exclusions. In order to avoid such a scenario, it is advisable to opt for a health plan which does not have an age limit or can be renewed even after reaching the age of sixty-five i.e. for lifetime. This is especially important if you include your parents in the health insurance policy or are yourself reaching an advanced age.

Conclusion

Always be careful when choosing a health insurance policy because you do not know what you may need when a medical problem arises. Choosing a health insurance policy is a serious task, and you should study the details of each policy closely. Most of the information related to the policies of different insurance providers are now available online and can be easily compared. Remember to compare the strengths and weaknesses of each policy and reach a fair decision to get the health plan that will help you the most.